Baseline Characteristics and Readmissions after Cerebral Venous Sinus Thrombosis in a Nationally Representative Database

Leavell, Yaowaree; Khalid, Mian; Tuhrim, Stanley; Dhamoon, Mandip S.

doi:10.1159/000495420

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…While anemia [ 11 - 13 ] and race [ 7 , 8 ] have previously been identified as risk factors for poor outcomes following CVT, we highlight a potentially novel role for the expected primary payer. Although Medicare patients have been previously noted to have higher readmission rates [ 14 ], we now see that Medicare patients also have increased severity of disease at the time of presentation and longer hospital LOS. Additionally, our study is the first of its kind to investigate race and CVT outcomes utilizing the large sample size of the NIS inpatient database, allowing us to report significant results with greater confidence.…”

Section: Discussionmentioning

confidence: 76%

“…While anemia is a well-established risk factor for CVT, the causality of this relationship is unknown and the association between anemia and African descent must be noted. Anemia may be an independent risk factor for CVT [ 14 ]; however, it may also be an epidemiologic phenomenon secondary to other prothrombotic factors. Potential causes for this discrepancy include an increased incidence of sickle cell disease and thalassemias among Blacks of African descent.…”

Section: Discussionmentioning

confidence: 99%

“…It should be noted that previous studies have found a significant association between lower socioeconomic status as well as the primary payer and rates of leaving against medical advice (AMA) [ 14 ]. Patients who leave AMA have been shown to have a 40% increase in one-year-morality and a higher risk of readmission [ 14 ]. This association was not controlled for in our analysis and represents a potential limitation to our study.…”

Section: Discussionmentioning

confidence: 99%

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Analyzing the Effects of Demographic Differences on Patient Outcomes Following Non-pyogenic Intracranial Venous Thrombosis

Labagnara¹,

Birnbaum²,

Unda³

et al. 2021

Cureus

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Objective: To investigate the effect of racial and demographic differences on the short-term outcome of patients following a non-pyogenic cerebral venous thrombosis. Methods: Data from the National Inpatient Sample were gathered from the years 2013 to 2016. Patients who had a non-pyogenic cerebral venous thrombosis were identified. Admissions of patients between different racial groups were compared. Outcome measures included inpatient mortality, length of stay (LOS), all patients refined diagnosis-related group (APR-DRG) severity and mortality risk scores, non-routine discharges, total charges, sepsis, and urinary tract infections (UTIs). Results: We identified 973 patients who were admitted with a non-pyogenic cerebral venous thrombosis between 2013 and 2016. Of those, 65.7% were classified as White, 15.6% as Black, 14.1% as Hispanic, and 4.6% as Asian or Pacific Islander. Compared to White patients, Black patients were found to have a higher severity score upon admission (2.94 ± 0.818 vs 2.77 ± 0.839; p = 0.025) as well as a longer adjusted LOS (8.085 ± 5.917 vs 6.503 ± 5.552; p = 0.004) and log LOS (0.934 ± 0.507 vs 0.773 ± 0.521; p = 0.001). On initial analysis, we found that older age, elevated WBC count, income group, anemia, and an expected primary payer of Medicare/Medicaid were significantly associated with Black race and also worse outcomes. When controlling for these variables using multivariate regression, older age, lower income group, and elevated WBC count were not significantly associated with any measures of outcome. The race was no longer associated with a higher APR-DRG severity score but was still significant for adjusted LOS (p = 0.001) and adjusted log LOS (p = 0.004). Lastly, we noted that anemia and the expected primary payer of Medicare/Medicaid were both independently and significantly associated with APR-DRG severity score (p = 0.003; p = 0.010) and the adjusted log LOS (p = 0.019; p = 0.035). Conclusions: Black patients admitted with a non-pyogenic intracranial venous thrombosis have significantly longer LOS compared to White patients. Anemia and Medicare/Medicaid as the primary expected payer also seem to play a role in longer LOS, as well as the severity of the case.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Analyzing the Effects of Demographic Differences on Patient Outcomes Following Non-pyogenic Intracranial Venous Thrombosis

Labagnara¹,

Birnbaum²,

Unda³

et al. 2021

Cureus

View full text Add to dashboard Cite

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“…24 Focal or generalized seizures occur in 20 to 40% of patients within the 2 weeks of diagnosis, which is a noticeably higher incidence than in arterial ischemic stroke (2-9%) or intracerebral hemorrhage (8-14%). [32][33][34] Eight of 10 people with acute symptomatic seizures have seizures before the diagnosis has been established. 2 CVT patients can also present as status epilepticus, or they may develop status epilepticus, particularly in severe forms with supratentorial and multiple hemorrhagic lesions.…”

Section: Clinical Presentationmentioning

confidence: 99%

Cerebral Venous Thrombosis

Aamodt

Skattør

2022

Semin Thromb Hemost

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Cerebral venous thrombosis (CVT) is a rare form of stroke that often affects younger age groups, especially reproductive age group females. CVT is a potentially fatal neurological condition that can be frequently overlooked due to the vague nature of its clinical and radiological presentation. Headache is the most common presenting symptom. However, a wide range of symptoms can be present and the symptom onset can be acute, subacute, or chronic. Neuroimaging is mandatory in cases where CVT is suspected. Both magnetic resonance venography and computed tomography venography can confirm a diagnosis of CVT. Anticoagulation with low-molecular-weight heparin is the mainstay of treatment. Intracranial hemorrhage is not considered a contraindication to the use of anticoagulants in CVT. Endovascular intervention is still controversial but can be a treatment option for patients with neurological deterioration or thrombus progression, despite the use of anticoagulation or with development of new or worsening intracerebral hemorrhage. Patients with CVT have an increased risk of recurrence of CVT and other types of venous thromboembolism. This review provides an overview of the epidemiology, diagnosis, and treatment of CVT in adults. Commentary about increased presentation of CVT in patients with coronavirus disease 2019 (COVID-19), or after immunization against COVID-19, is also provided.

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“…Approximately, 16% of patients with CVT have seizures. [ 3 ] Seizures were most common in patients with hemorrhagic conversion or with superior sagittal sinus vein and cortical vein thrombosis. [ 4 5 ] A cranial nerve six palsy is the most common cranial nerve palsy in CVT.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Venous Thrombosis in Pregnant and Postpartum Women Presenting to the Emergency Department with Headaches

Grossberg,

Galwankar

2024

Journal of Emergencies, Trauma, and Shock

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Introduction: Cerebral venous thrombosis (CVT) is a thromboembolic disease of the intracranial venous systems. The disease can be difficult to diagnose as it often requires a high index of suspicion. Risk factors for the disease include pregnancy, oral contraceptive pills, congenital thrombophilia, infection, cancer, polycythemia, head trauma, and recent surgery. However, there have been no studies in the United States that have examined whether pregnancy and the postpartum stage are truly a risk factor for CVT. The aim of this study is to determine whether pregnant and postpartum women presenting to the emergency department with headaches have a higher incidence of CVT to better risk stratify which patients need to have advanced imaging pursued. Methods: A retrospective, observational case–control study was performing by querying the electronic medical record at a large county hospital for patients presenting with a headache to the emergency department. Patients were stratified into groups based on whether they were diagnosed with CVT, pregnancy status, and comorbid conditions to determine the risk associated between pregnancy, the puerperium stage, and CVT. Results: A total of 20,955 males and females presented to the emergency department between January 1, 2016 and April 13, 2023, with a chief complaint of headache. There were 19,474 female patients and 9581 male patients. In the case group, there were 793 pregnant women and 53 postpartum women. In the control group, there were 18,628 women who were not pregnant. Of the 22 patients diagnosed with CVT, 1 was in the puerperium stage and no patients were pregnant. Pregnant and postpartum patients were 1.05 (0.14–7.80) times more likely to develop CVT. Pregnant and postpartum patients were 1.73 (0.23–13.52) times more likely to develop CVT when controlled for comorbidities. Patients in the puerperium stage were 26.48 (3.33–210.87) times more likely to develop CVT when controlled for comorbidities. Conclusion: Pregnant patients presenting to the emergency department with headaches do not have a significantly higher risk of CVT; however, puerperium patients have a significantly higher risk of CVT compared to the general population.

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Baseline Characteristics and Readmissions after Cerebral Venous Sinus Thrombosis in a Nationally Representative Database

Cited by 6 publications

References 22 publications

Analyzing the Effects of Demographic Differences on Patient Outcomes Following Non-pyogenic Intracranial Venous Thrombosis

Analyzing the Effects of Demographic Differences on Patient Outcomes Following Non-pyogenic Intracranial Venous Thrombosis

Cerebral Venous Thrombosis

Cerebral Venous Thrombosis in Pregnant and Postpartum Women Presenting to the Emergency Department with Headaches

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